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Use of Oxaliplatin for Cholangiocarcinoma?
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J
medicine forum addict


Joined: 07 May 2005
Posts: 93

PostPosted: Tue Jun 14, 2005 6:13 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

farrell77 wrote:

Quote:
"J" <colourful@invalid.anon> wrote in message
news:42ADCF87.4AC50911@execulink.com...
farrell77 wrote:

Yes. Eight three-week cycles of gemcitabine and
capecitabine. A scan after the first few cycles in
December showed some tumor reduction. A scan
in April after the eight cycles were completed showed
stabilization but no further reduction. So two additional
cycles of the same drugs were used. Now he's on
cisplatin (rather than oxaliplatin) and gemcitabine.

What kinds of symptoms, for example? He has extreme
fatigue at times, severe pain, poor appetite, and weight loss.
I presume that the chemo drugs aggravate, rather than
alleviate, these symptoms. He seems willing to tolerate
them for now.

Well, it could be the cancer also and/or what other organs are involved.
Does he have jaundice? Have they put in a stent?

Not being on the scene (I'm in WNY; he's in Honolulu),
it's sometimes hard for me to get info, which is almost
always second-hand, except for when I visited for a week
last November. I'll do my best below with your questions.

Yes, he's had jaundice. They put in two stents last summer
(one for each lobe of the liver). Recently (within the past
month), they had to replace both stents. His doctor has
expressed concern over the facts that (1) the stents have
to keep getting bigger - presumably to accomodate the
growing size of the tumor? - and (2) there's risk of very
dangerous infections from the stents.

So it may come to what are the chances that the chemo will
extend his life and inprove life quality over the longer run.
From your next reference, the chances seem very small of
extending his life. My impression now is that in the absence
of other alternatives, he's still willing to try the chemo. He
was frustrated when there was a month gap from the end
of the capecitabine / gemcitabine trial and the start of the
current cisplatin / gemcitabine trial. He wanted to be at
least trying something.
J wrote:> Here's another one about chemotherapy that you may not wish to
read,
but should
be made aware of

http://groups-beta.google.com/group/alt.support.cancer/msg/4befa08191d468b3

From that, the chemo approach sounds not very promising.
I just learned over the weekend that his doctors have now
determined that he's a candidate for radiation, starting
this week. The cisplatin / gemcitabine chemo treatments
will continue, and radiation will be used 5 days a week for
4 to 8 weeks.

Hello,
I'm hopeful hearing that he's a candidate for radiiation therapy.
I'd like Steph to step in here. I don't want to see your brother
over-treated
(which happens in some countries).
Could you please describe the extent of his disease?
I'm assuming since he wasn't a surgical candidate, it's intrahepatic
(ducts
inside the liver) ?
Where else?

It started in the bile duct inside the liver. Initially, we were
looking at a liver transplant in Pittsburgh with me as the donor
(having a blood type that would work). However scans
showed metastasis and so the focus shifted.

Some other background: he had ulcerative colitis at age 17,
which apparently led to sclerosing cholangitis later and then to
cholangiocarcinoma, which was diagnosed last August. Scans
in September 2004 showed metastasis to one lung and to one
other site: either stomach or back. Other organs, such as gall
bladder and pancreas are *not* involved at this time as far as I
know.

http://www.cancerbacup.org.uk/Cancertype/Bileduct/Bileduct (providing
these as
prompters)
# The cancer has spread into the liver, pancreas or gall bladder or to the
nearby blood vessels, but not the lymph nodes.
# Stage 2B The cancer has spread into nearby lymph nodes.
# Stage 3 The cancer is affecting the main blood vessels that take blood
to and
from the liver, or it has spread into the small or large bowel, the
stomach or
the abdominal wall. Lymph nodes in the abdomen may also be affected.
# Stage 4 The cancer has spread to distant parts of the body such as the
lungs.

and now I'm a little confused (I'm not a doctor) because this webpage says
that
"most bile duct cancers come from cancers that originated in the
pancreas."
http://cancer.stanfordhospital.com/healthInfo/cancerTypes/bileDuct/
(yet the other one, above, says that's where it can spread to, unless
they're
referring to extra-hepatic).

His started in the bile duct, intra-hepatic.

So what organs are involved? And where exactly is his pain(s)?

Organs involved are bile duct, liver (not sure if damage is from
metastasis or the duct tumors pushing on it), one lung, and either
stomach or back. Pain is in these areas and, as he puts it,
seems to move around.

I guess I'm also wondering, if you think the chemo is causing some of the
pains,
how will you know if the radiation therapy worked, if he has radiation and
then
right back on chemo?

The plan as described to me last night is to do the two (chemo
and radiation) in parallel. The chemo has already been started
and last week he received his second dose. He continues with
this every third week. The radiation will start this Thursday and
take place 5 days a week. So there will be overlap in the two
approaches.


Thanks for answering my questions.
I understand. It's hard to know exactly where they'll be doing the radiation
therapy.
I'll watch for your updates.
Best,
J
Back to top
J
medicine forum addict


Joined: 07 May 2005
Posts: 93

PostPosted: Tue Jun 14, 2005 6:08 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

farrell77 wrote:

Quote:
"J" <Hiss-ss-ss@example.org> wrote in message

[...snipped...]

Here's another one about chemotherapy that you may not wish to read, but
should
be made aware of

http://groups-beta.google.com/group/alt.support.cancer/msg/4befa08191d468b3

The results of this study jump out at you:

*************************
RESULTS: The overall contribution of curative and
adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated
to be 2.3% in Australia and 2.1% in the USA. CONCLUSION: As the 5-year
relative survival rate for cancer in Australia is now over 60%, it is clear
that cytotoxic chemotherapy only makes a minor contribution to cancer
survival. To justify the continued funding and availability of drugs used in
cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and
impact on quality of life is urgently required.
*************************

Yet when I've talked with people at some major cancer
centers, I find that there are many chemotherapy clinical
trials going on. So we must be spending big money on
something that doesn't seem to be that promising, as far
as survival rate goes. Am I missing something?

I'm not sure what to reply to your question.
There's always going to be research.
There's always going to be searches for cures for many diseases.

Quote:
Having the above and some grasp of tumor cell shedding, doubling
times/tumor
growth, clones and chemo resistant clones might also help.
I would suggest that you look for a text.
I think it's called "Principles and Practise of Oncology" by De Vita

A quick search online turned up some copies with
variable publication years and prices all over the
place. Prices were as high as $250 for the two volume
set published in 2005 and much less for just volume 2
alone published in 2004. I assume it's important to get
both volumes of the most recent date?

[...snipped...]

I wouldn't think so, but not sure.
I've been meaning to check the library to see if they have older versions, but
haven't got there yet.
J
Back to top
farrell77
medicine forum beginner


Joined: 01 Jun 2005
Posts: 47

PostPosted: Mon Jun 13, 2005 6:17 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

"J" <Hiss-ss-ss@example.org> wrote in message
news:42AB680F.6AAC1FFB@execulink.com...

[...snipped...]

Quote:
Here's another one about chemotherapy that you may not wish to read, but
should
be made aware of

http://groups-beta.google.com/group/alt.support.cancer/msg/4befa08191d468b3


The results of this study jump out at you:

*************************
RESULTS: The overall contribution of curative and
adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated
to be 2.3% in Australia and 2.1% in the USA. CONCLUSION: As the 5-year
relative survival rate for cancer in Australia is now over 60%, it is clear
that cytotoxic chemotherapy only makes a minor contribution to cancer
survival. To justify the continued funding and availability of drugs used in
cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and
impact on quality of life is urgently required.
*************************

Yet when I've talked with people at some major cancer
centers, I find that there are many chemotherapy clinical
trials going on. So we must be spending big money on
something that doesn't seem to be that promising, as far
as survival rate goes. Am I missing something?


Quote:
Having the above and some grasp of tumor cell shedding, doubling
times/tumor
growth, clones and chemo resistant clones might also help.
I would suggest that you look for a text.
I think it's called "Principles and Practise of Oncology" by De Vita

A quick search online turned up some copies with
variable publication years and prices all over the
place. Prices were as high as $250 for the two volume
set published in 2005 and much less for just volume 2
alone published in 2004. I assume it's important to get
both volumes of the most recent date?


[...snipped...]
Back to top
farrell77
medicine forum beginner


Joined: 01 Jun 2005
Posts: 47

PostPosted: Mon Jun 13, 2005 5:13 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

"J" <colourful@invalid.anon> wrote in message
news:42ADCF87.4AC50911@execulink.com...
Quote:
farrell77 wrote:

Yes. Eight three-week cycles of gemcitabine and
capecitabine. A scan after the first few cycles in
December showed some tumor reduction. A scan
in April after the eight cycles were completed showed
stabilization but no further reduction. So two additional
cycles of the same drugs were used. Now he's on
cisplatin (rather than oxaliplatin) and gemcitabine.

What kinds of symptoms, for example? He has extreme
fatigue at times, severe pain, poor appetite, and weight loss.
I presume that the chemo drugs aggravate, rather than
alleviate, these symptoms. He seems willing to tolerate
them for now.

Well, it could be the cancer also and/or what other organs are involved.
Does he have jaundice? Have they put in a stent?

Not being on the scene (I'm in WNY; he's in Honolulu),
it's sometimes hard for me to get info, which is almost
always second-hand, except for when I visited for a week
last November. I'll do my best below with your questions.

Yes, he's had jaundice. They put in two stents last summer
(one for each lobe of the liver). Recently (within the past
month), they had to replace both stents. His doctor has
expressed concern over the facts that (1) the stents have
to keep getting bigger - presumably to accomodate the
growing size of the tumor? - and (2) there's risk of very
dangerous infections from the stents.


Quote:
So it may come to what are the chances that the chemo will
extend his life and inprove life quality over the longer run.
From your next reference, the chances seem very small of
extending his life. My impression now is that in the absence
of other alternatives, he's still willing to try the chemo. He
was frustrated when there was a month gap from the end
of the capecitabine / gemcitabine trial and the start of the
current cisplatin / gemcitabine trial. He wanted to be at
least trying something.
J wrote:> Here's another one about chemotherapy that you may not wish to
read,
but should
be made aware of

http://groups-beta.google.com/group/alt.support.cancer/msg/4befa08191d468b3

From that, the chemo approach sounds not very promising.
I just learned over the weekend that his doctors have now
determined that he's a candidate for radiation, starting
this week. The cisplatin / gemcitabine chemo treatments
will continue, and radiation will be used 5 days a week for
4 to 8 weeks.

Hello,
I'm hopeful hearing that he's a candidate for radiiation therapy.
I'd like Steph to step in here. I don't want to see your brother
over-treated
(which happens in some countries).
Could you please describe the extent of his disease?
I'm assuming since he wasn't a surgical candidate, it's intrahepatic
(ducts
inside the liver) ?
Where else?

It started in the bile duct inside the liver. Initially, we were
looking at a liver transplant in Pittsburgh with me as the donor
(having a blood type that would work). However scans
showed metastasis and so the focus shifted.

Some other background: he had ulcerative colitis at age 17,
which apparently led to sclerosing cholangitis later and then to
cholangiocarcinoma, which was diagnosed last August. Scans
in September 2004 showed metastasis to one lung and to one
other site: either stomach or back. Other organs, such as gall
bladder and pancreas are *not* involved at this time as far as I
know.


Quote:
http://www.cancerbacup.org.uk/Cancertype/Bileduct/Bileduct (providing
these as
prompters)
# The cancer has spread into the liver, pancreas or gall bladder or to the
nearby blood vessels, but not the lymph nodes.
# Stage 2B The cancer has spread into nearby lymph nodes.
# Stage 3 The cancer is affecting the main blood vessels that take blood
to and
from the liver, or it has spread into the small or large bowel, the
stomach or
the abdominal wall. Lymph nodes in the abdomen may also be affected.
# Stage 4 The cancer has spread to distant parts of the body such as the
lungs.

and now I'm a little confused (I'm not a doctor) because this webpage says
that
"most bile duct cancers come from cancers that originated in the
pancreas."
http://cancer.stanfordhospital.com/healthInfo/cancerTypes/bileDuct/
(yet the other one, above, says that's where it can spread to, unless
they're
referring to extra-hepatic).

His started in the bile duct, intra-hepatic.


Quote:
So what organs are involved? And where exactly is his pain(s)?

Organs involved are bile duct, liver (not sure if damage is from
metastasis or the duct tumors pushing on it), one lung, and either
stomach or back. Pain is in these areas and, as he puts it,
seems to move around.


Quote:
I guess I'm also wondering, if you think the chemo is causing some of the
pains,
how will you know if the radiation therapy worked, if he has radiation and
then
right back on chemo?

The plan as described to me last night is to do the two (chemo
and radiation) in parallel. The chemo has already been started
and last week he received his second dose. He continues with
this every third week. The radiation will start this Thursday and
take place 5 days a week. So there will be overlap in the two
approaches.


Quote:
So if you could please provide more details, then let's see what Steph
contributes.
Thank you.

And of course, I'll keep you all in my thoughts.
J

Again, thank you very much.
Back to top
J
medicine forum addict


Joined: 07 May 2005
Posts: 93

PostPosted: Mon Jun 13, 2005 4:25 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

farrell77 wrote:

Quote:
Yes. Eight three-week cycles of gemcitabine and
capecitabine. A scan after the first few cycles in
December showed some tumor reduction. A scan
in April after the eight cycles were completed showed
stabilization but no further reduction. So two additional
cycles of the same drugs were used. Now he's on
cisplatin (rather than oxaliplatin) and gemcitabine.

What kinds of symptoms, for example? He has extreme
fatigue at times, severe pain, poor appetite, and weight loss.
I presume that the chemo drugs aggravate, rather than
alleviate, these symptoms. He seems willing to tolerate
them for now.

Well, it could be the cancer also and/or what other organs are involved.
Does he have jaundice? Have they put in a stent?

Quote:
So it may come to what are the chances that the chemo will
extend his life and inprove life quality over the longer run.
From your next reference, the chances seem very small of
extending his life. My impression now is that in the absence
of other alternatives, he's still willing to try the chemo. He
was frustrated when there was a month gap from the end
of the capecitabine / gemcitabine trial and the start of the
current cisplatin / gemcitabine trial. He wanted to be at
least trying something.
J wrote:> Here's another one about chemotherapy that you may not wish to read,
but should
be made aware of
http://groups-beta.google.com/group/alt.support.cancer/msg/4befa08191d468b3

From that, the chemo approach sounds not very promising.
I just learned over the weekend that his doctors have now
determined that he's a candidate for radiation, starting
this week. The cisplatin / gemcitabine chemo treatments
will continue, and radiation will be used 5 days a week for
4 to 8 weeks.

Hello,
I'm hopeful hearing that he's a candidate for radiiation therapy.
I'd like Steph to step in here. I don't want to see your brother over-treated
(which happens in some countries).
Could you please describe the extent of his disease?
I'm assuming since he wasn't a surgical candidate, it's intrahepatic (ducts
inside the liver) ?
Where else?

http://www.cancerbacup.org.uk/Cancertype/Bileduct/Bileduct (providing these as
prompters)
# The cancer has spread into the liver, pancreas or gall bladder or to the
nearby blood vessels, but not the lymph nodes.
# Stage 2B The cancer has spread into nearby lymph nodes.
# Stage 3 The cancer is affecting the main blood vessels that take blood to and
from the liver, or it has spread into the small or large bowel, the stomach or
the abdominal wall. Lymph nodes in the abdomen may also be affected.
# Stage 4 The cancer has spread to distant parts of the body such as the lungs.

and now I'm a little confused (I'm not a doctor) because this webpage says that
"most bile duct cancers come from cancers that originated in the pancreas."
http://cancer.stanfordhospital.com/healthInfo/cancerTypes/bileDuct/
(yet the other one, above, says that's where it can spread to, unless they're
referring to extra-hepatic).

So what organs are involved? And where exactly is his pain(s)?

I guess I'm also wondering, if you think the chemo is causing some of the pains,
how will you know if the radiation therapy worked, if he has radiation and then
right back on chemo?

So if you could please provide more details, then let's see what Steph
contributes.
Thank you.

And of course, I'll keep you all in my thoughts.
J
Back to top
J
medicine forum addict


Joined: 07 May 2005
Posts: 93

PostPosted: Sat Jun 11, 2005 8:39 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

farrell77 wrote:

Quote:
"J" <Hiss-ss-ss@example.org> wrote in message
news:42A5FAD8.344B60BF@execulink.com...
farrell77 wrote:

"Steph" <steph@vancouvers.island> wrote in message
news:yttne.1538978$6l.772567@pd7tw2no...

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:Ifone.503$Wk4.11300@news.uswest.net...
Can anyone provide references or data that could help persuade an
insurance
company to pay for oxaliplatin to treat cholangiocarcinoma?
Insurance
claims have been denied, apparently on grounds that this is not a
standard

treatment. Thanks.



What do you expect oxaliplatin to achieve?

Options and time are running short, and it's been suggested by several
doctors
(as a treatment for my brother).

Here's one abstract I received from a doctor at a major cancer center:

A phase II study of Oxaliplatin (O) and Gemcitabine (G) first line
chemotherapy
in patients with advanced biliary tract cancers. Abstract No: 4132

It's a small trial and first line Phase II - presumably your brother's
had
other treatments? Including gemcitabine (Gemzar) ?

Yes. Eight three-week cycles of gemcitabine and
capecitabine. A scan after the first few cycles in
December showed some tumor reduction. A scan
in April after the eight cycles were completed showed
stabilization but no further reduction. So two additional
cycles of the same drugs were used. Now he's on
cisplatin (rather than oxaliplatin) and gemcitabine.

http://www.cancerguide.org/small_trial_stats.html
Why Good Results From Small Trials Often Don't Pan Out

Interesting.

It's been in Phase III (palliative) for 2 years now for pancreatic; a
cancer
that usually carries a similar prognosis.
http://www.clinicaltrials.gov/ct/gui/show/NCT00075452
This randomized phase III trial is studying gemcitabine and oxaliplatin to
see
how well they work compared to gemcitabine alone in treating patients with
locally advanced or metastatic unresectable pancreatic adenocarcinoma.

How is your brother, Bob?
J

Okay last week when we spoke on the phone
(thanks for asking). But he obviously faces a very
difficult situation.

Thanks for replying. I was looking to find out if he has symptoms (that a chemo
might help more than hurt).

When cure is no longer possible, we often post Steph's questions to ask.
Please see http://tinyurl.com/4akk6 for his algorithm about treatment decisions
I know it's hard to be dispassionate and objective when it's our loved ones.

Here's another one about chemotherapy that you may not wish to read, but should
be made aware of
http://groups-beta.google.com/group/alt.support.cancer/msg/4befa08191d468b3

Having the above and some grasp of tumor cell shedding, doubling times/tumor
growth, clones and chemo resistant clones might also help.
I would suggest that you look for a text.
I think it's called "Principles and Practise of Oncology" by De Vita
That way you and your brother can have an understanding and make decisions based
on facts.
I realize only your brother can make his decision as to whether he wants to go
for it, in the face of perhaps toxicities or whether he wants to focus on other
things that he would rather do with the rest of his life/quality of life issues.

You'll both be in my thoughts.
Post anytime or join us on alt.support.cancer
I'll watch for yuor updates on either newsgroup
J
Back to top
Steph
medicine forum Guru


Joined: 03 May 2005
Posts: 504

PostPosted: Wed Jun 08, 2005 11:07 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:HBIpe.41$OO1.5299@news.uswest.net...
Quote:
"Steph" <steph@vancouvers.island> wrote in message
news:93xpe.1597711$6l.117315@pd7tw2no...

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:gOkpe.29$y61.4339@news.uswest.net...
"Steph" <steph@vancouvers.island> wrote in message
news:yttne.1538978$6l.772567@pd7tw2no...

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:Ifone.503$Wk4.11300@news.uswest.net...
Can anyone provide references or data that could help persuade an
insurance
company to pay for oxaliplatin to treat cholangiocarcinoma?
Insurance
claims have been denied, apparently on grounds that this is not a
standard
treatment. Thanks.

- Bob



What do you expect oxaliplatin to achieve?

Options and time are running short, and it's been suggested by several
doctors
(as a treatment for my brother).

Here's one abstract I received from a doctor at a major cancer center:

A phase II study of Oxaliplatin (O) and Gemcitabine (G) first line
chemotherapy
in patients with advanced biliary tract cancers. Abstract No: 4132
Author(s): N.
Gebbia, F. Verderame, R. Di Leo, D. Santangelo, G. Cicero, M. Valerio,
C.
Arcara, G. Badalamenti, F. Fulfaro, I. Carreca Abstract: Background:
Biliary
tract cancers are uncommon tumors with a poor prognosis and most
patients
(pts)
present with invasive and inoperable disease at diagnosis. Chemotherapy
represents a palliative treatment, but single or combination-drug
schedules
have
demonstrated poor response rates with a median survival less than 6
months.Recently O and G have showed an interesting activity as single
agents
in
this group of pts. Methods: We carried out a multicenter phase II study
to
evaluate the efficacy and safety of combined O and G in locally
advanced
and
metastatic biliary tract carcinoma. The schedule of chemotherapy
included
O
100
mg/m2 on day 1 and G 1000 mg/m2 on days 1 and 8, every 21 days.
Inclusion
Criteria were: histological diagnosis of biliary tract carcinoma, age
75,
Performance Status (PS)<=2, normal kidney and liver function, absence
of
brain
symptomatic metastases, informed consent.Median patient age was 68
years
(range
59 -73). At present 24 pts ,15 males and 9 females, have been enrolled.
Nine
pts
had carcinoma of the gallbladder, 7 cholangiocarcinoma and 8
extrahepatic
biliary system disease. Locally advanced 14 pts, metastatic 10 pts.
Thirteen
pts
had a PS =0, 7 pts had a PS=1, 4 pts had a PS=2. Results: All the 24
pts
were
evaluable for response and toxicity. According RECIST criteria we
observed
1
CR
and 11 PR for an overall response rate of 50 %. Five SD and 7 PD also
occurred.
The responders (PR+CR) demonstrated a TTP of 10 months (range 6-24) and
an
overall survival of 14 months (range 6 - 2Cool, while the overall
survival
for
all
the pts on study was 10 months (range 2-2Cool. According WHO criteria, 6
pts
(25%)
suffered grade 2-3 neutropenia, and 3 pts (12.5%) grade 2
thrombocytopenia.
One
third of pts developed grade 1-2- peripheral neuropathy, only 2 pts
(8%)
suffered grade 3 neuropathy . Nausea & vomiting G1-2 was present in 6
pts
(25%).Conclusions: From these preliminary data O and G combination
seems
to
be
effective with a favorable safety profile in first line chemotherapy of
advanced
biliary tract cancers.




As part of a trial, it is entirely justified, but don't develop
unrealistic
expectations based on a small phase II trial............
It's pretty toxic, can't lead to a cure, and the survival benefit is
modest
at best

Are there better options in your opinion? Other drugs
that have been suggested to me are irinotecan (with or
without selenium) and darceva.




It all depemds on the clinical picture - extent of disease, symptoms, etc.
Back to top
farrell77
medicine forum beginner


Joined: 01 Jun 2005
Posts: 47

PostPosted: Wed Jun 08, 2005 6:32 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

"Steph" <steph@vancouvers.island> wrote in message
news:93xpe.1597711$6l.117315@pd7tw2no...
Quote:

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:gOkpe.29$y61.4339@news.uswest.net...
"Steph" <steph@vancouvers.island> wrote in message
news:yttne.1538978$6l.772567@pd7tw2no...

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:Ifone.503$Wk4.11300@news.uswest.net...
Can anyone provide references or data that could help persuade an
insurance
company to pay for oxaliplatin to treat cholangiocarcinoma?
Insurance
claims have been denied, apparently on grounds that this is not a
standard
treatment. Thanks.

- Bob



What do you expect oxaliplatin to achieve?

Options and time are running short, and it's been suggested by several
doctors
(as a treatment for my brother).

Here's one abstract I received from a doctor at a major cancer center:

A phase II study of Oxaliplatin (O) and Gemcitabine (G) first line
chemotherapy
in patients with advanced biliary tract cancers. Abstract No: 4132
Author(s): N.
Gebbia, F. Verderame, R. Di Leo, D. Santangelo, G. Cicero, M. Valerio,
C.
Arcara, G. Badalamenti, F. Fulfaro, I. Carreca Abstract: Background:
Biliary
tract cancers are uncommon tumors with a poor prognosis and most
patients
(pts)
present with invasive and inoperable disease at diagnosis. Chemotherapy
represents a palliative treatment, but single or combination-drug
schedules
have
demonstrated poor response rates with a median survival less than 6
months.Recently O and G have showed an interesting activity as single
agents
in
this group of pts. Methods: We carried out a multicenter phase II study
to
evaluate the efficacy and safety of combined O and G in locally advanced
and
metastatic biliary tract carcinoma. The schedule of chemotherapy
included
O
100
mg/m2 on day 1 and G 1000 mg/m2 on days 1 and 8, every 21 days.
Inclusion
Criteria were: histological diagnosis of biliary tract carcinoma, age
75,
Performance Status (PS)<=2, normal kidney and liver function, absence of
brain
symptomatic metastases, informed consent.Median patient age was 68 years
(range
59 -73). At present 24 pts ,15 males and 9 females, have been enrolled.
Nine
pts
had carcinoma of the gallbladder, 7 cholangiocarcinoma and 8
extrahepatic
biliary system disease. Locally advanced 14 pts, metastatic 10 pts.
Thirteen
pts
had a PS =0, 7 pts had a PS=1, 4 pts had a PS=2. Results: All the 24 pts
were
evaluable for response and toxicity. According RECIST criteria we
observed
1
CR
and 11 PR for an overall response rate of 50 %. Five SD and 7 PD also
occurred.
The responders (PR+CR) demonstrated a TTP of 10 months (range 6-24) and
an
overall survival of 14 months (range 6 - 2Cool, while the overall survival
for
all
the pts on study was 10 months (range 2-2Cool. According WHO criteria, 6
pts
(25%)
suffered grade 2-3 neutropenia, and 3 pts (12.5%) grade 2
thrombocytopenia.
One
third of pts developed grade 1-2- peripheral neuropathy, only 2 pts (8%)
suffered grade 3 neuropathy . Nausea & vomiting G1-2 was present in 6
pts
(25%).Conclusions: From these preliminary data O and G combination seems
to
be
effective with a favorable safety profile in first line chemotherapy of
advanced
biliary tract cancers.




As part of a trial, it is entirely justified, but don't develop
unrealistic
expectations based on a small phase II trial............
It's pretty toxic, can't lead to a cure, and the survival benefit is
modest
at best

Are there better options in your opinion? Other drugs
that have been suggested to me are irinotecan (with or
without selenium) and darceva.
Back to top
farrell77
medicine forum beginner


Joined: 01 Jun 2005
Posts: 47

PostPosted: Wed Jun 08, 2005 6:28 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

"J" <Hiss-ss-ss@example.org> wrote in message
news:42A5FAD8.344B60BF@execulink.com...
Quote:
farrell77 wrote:

"Steph" <steph@vancouvers.island> wrote in message
news:yttne.1538978$6l.772567@pd7tw2no...

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:Ifone.503$Wk4.11300@news.uswest.net...
Can anyone provide references or data that could help persuade an
insurance
company to pay for oxaliplatin to treat cholangiocarcinoma?
Insurance
claims have been denied, apparently on grounds that this is not a
standard

treatment. Thanks.



What do you expect oxaliplatin to achieve?

Options and time are running short, and it's been suggested by several
doctors
(as a treatment for my brother).

Here's one abstract I received from a doctor at a major cancer center:

A phase II study of Oxaliplatin (O) and Gemcitabine (G) first line
chemotherapy
in patients with advanced biliary tract cancers. Abstract No: 4132

It's a small trial and first line Phase II - presumably your brother's
had
other treatments? Including gemcitabine (Gemzar) ?

Yes. Eight three-week cycles of gemcitabine and
capecitabine. A scan after the first few cycles in
December showed some tumor reduction. A scan
in April after the eight cycles were completed showed
stabilization but no further reduction. So two additional
cycles of the same drugs were used. Now he's on
cisplatin (rather than oxaliplatin) and gemcitabine.


Quote:
http://www.cancerguide.org/small_trial_stats.html
Why Good Results From Small Trials Often Don't Pan Out

Interesting.


Quote:
It's been in Phase III (palliative) for 2 years now for pancreatic; a
cancer
that usually carries a similar prognosis.
http://www.clinicaltrials.gov/ct/gui/show/NCT00075452
This randomized phase III trial is studying gemcitabine and oxaliplatin to
see
how well they work compared to gemcitabine alone in treating patients with
locally advanced or metastatic unresectable pancreatic adenocarcinoma.

How is your brother, Bob?
J

Okay last week when we spoke on the phone
(thanks for asking). But he obviously faces a very
difficult situation.
Back to top
Steph
medicine forum Guru


Joined: 03 May 2005
Posts: 504

PostPosted: Wed Jun 08, 2005 5:24 am    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:gOkpe.29$y61.4339@news.uswest.net...
Quote:
"Steph" <steph@vancouvers.island> wrote in message
news:yttne.1538978$6l.772567@pd7tw2no...

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:Ifone.503$Wk4.11300@news.uswest.net...
Can anyone provide references or data that could help persuade an
insurance
company to pay for oxaliplatin to treat cholangiocarcinoma? Insurance
claims have been denied, apparently on grounds that this is not a
standard
treatment. Thanks.

- Bob



What do you expect oxaliplatin to achieve?

Options and time are running short, and it's been suggested by several
doctors
(as a treatment for my brother).

Here's one abstract I received from a doctor at a major cancer center:

A phase II study of Oxaliplatin (O) and Gemcitabine (G) first line
chemotherapy
in patients with advanced biliary tract cancers. Abstract No: 4132
Author(s): N.
Gebbia, F. Verderame, R. Di Leo, D. Santangelo, G. Cicero, M. Valerio, C.
Arcara, G. Badalamenti, F. Fulfaro, I. Carreca Abstract: Background:
Biliary
tract cancers are uncommon tumors with a poor prognosis and most patients
(pts)
present with invasive and inoperable disease at diagnosis. Chemotherapy
represents a palliative treatment, but single or combination-drug
schedules
have
demonstrated poor response rates with a median survival less than 6
months.Recently O and G have showed an interesting activity as single
agents
in
this group of pts. Methods: We carried out a multicenter phase II study to
evaluate the efficacy and safety of combined O and G in locally advanced
and
metastatic biliary tract carcinoma. The schedule of chemotherapy included
O
100
mg/m2 on day 1 and G 1000 mg/m2 on days 1 and 8, every 21 days. Inclusion
Criteria were: histological diagnosis of biliary tract carcinoma, age <75,
Performance Status (PS)<=2, normal kidney and liver function, absence of
brain
symptomatic metastases, informed consent.Median patient age was 68 years
(range
59 -73). At present 24 pts ,15 males and 9 females, have been enrolled.
Nine
pts
had carcinoma of the gallbladder, 7 cholangiocarcinoma and 8 extrahepatic
biliary system disease. Locally advanced 14 pts, metastatic 10 pts.
Thirteen
pts
had a PS =0, 7 pts had a PS=1, 4 pts had a PS=2. Results: All the 24 pts
were
evaluable for response and toxicity. According RECIST criteria we observed
1
CR
and 11 PR for an overall response rate of 50 %. Five SD and 7 PD also
occurred.
The responders (PR+CR) demonstrated a TTP of 10 months (range 6-24) and an
overall survival of 14 months (range 6 - 2Cool, while the overall survival
for
all
the pts on study was 10 months (range 2-2Cool. According WHO criteria, 6 pts
(25%)
suffered grade 2-3 neutropenia, and 3 pts (12.5%) grade 2
thrombocytopenia.
One
third of pts developed grade 1-2- peripheral neuropathy, only 2 pts (8%)
suffered grade 3 neuropathy . Nausea & vomiting G1-2 was present in 6 pts
(25%).Conclusions: From these preliminary data O and G combination seems
to
be
effective with a favorable safety profile in first line chemotherapy of
advanced
biliary tract cancers.




As part of a trial, it is entirely justified, but don't develop unrealistic
expectations based on a small phase II trial............
It's pretty toxic, can't lead to a cure, and the survival benefit is modest
at best
Back to top
J
medicine forum addict


Joined: 07 May 2005
Posts: 93

PostPosted: Tue Jun 07, 2005 5:51 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

farrell77 wrote:

Quote:
"Steph" <steph@vancouvers.island> wrote in message
news:yttne.1538978$6l.772567@pd7tw2no...

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:Ifone.503$Wk4.11300@news.uswest.net...
Can anyone provide references or data that could help persuade an
insurance
company to pay for oxaliplatin to treat cholangiocarcinoma? Insurance
claims have been denied, apparently on grounds that this is not a standard

treatment. Thanks.



What do you expect oxaliplatin to achieve?

Options and time are running short, and it's been suggested by several
doctors
(as a treatment for my brother).

Here's one abstract I received from a doctor at a major cancer center:

A phase II study of Oxaliplatin (O) and Gemcitabine (G) first line
chemotherapy
in patients with advanced biliary tract cancers. Abstract No: 4132

It's a small trial and first line Phase II - presumably your brother's had
other treatments? Including gemcitabine (Gemzar) ?
http://www.cancerguide.org/small_trial_stats.html
Why Good Results From Small Trials Often Don't Pan Out

It's been in Phase III (palliative) for 2 years now for pancreatic; a cancer
that usually carries a similar prognosis.
http://www.clinicaltrials.gov/ct/gui/show/NCT00075452
This randomized phase III trial is studying gemcitabine and oxaliplatin to see
how well they work compared to gemcitabine alone in treating patients with
locally advanced or metastatic unresectable pancreatic adenocarcinoma.

How is your brother, Bob?
J
Back to top
farrell77
medicine forum beginner


Joined: 01 Jun 2005
Posts: 47

PostPosted: Tue Jun 07, 2005 3:27 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

"Steph" <steph@vancouvers.island> wrote in message
news:yttne.1538978$6l.772567@pd7tw2no...
Quote:

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:Ifone.503$Wk4.11300@news.uswest.net...
Can anyone provide references or data that could help persuade an
insurance
company to pay for oxaliplatin to treat cholangiocarcinoma? Insurance
claims have been denied, apparently on grounds that this is not a
standard
treatment. Thanks.

- Bob



What do you expect oxaliplatin to achieve?

Options and time are running short, and it's been suggested by several
doctors
(as a treatment for my brother).

Here's one abstract I received from a doctor at a major cancer center:

A phase II study of Oxaliplatin (O) and Gemcitabine (G) first line
chemotherapy
in patients with advanced biliary tract cancers. Abstract No: 4132
Author(s): N.
Gebbia, F. Verderame, R. Di Leo, D. Santangelo, G. Cicero, M. Valerio, C.
Arcara, G. Badalamenti, F. Fulfaro, I. Carreca Abstract: Background: Biliary
tract cancers are uncommon tumors with a poor prognosis and most patients
(pts)
present with invasive and inoperable disease at diagnosis. Chemotherapy
represents a palliative treatment, but single or combination-drug schedules
have
demonstrated poor response rates with a median survival less than 6
months.Recently O and G have showed an interesting activity as single agents
in
this group of pts. Methods: We carried out a multicenter phase II study to
evaluate the efficacy and safety of combined O and G in locally advanced and
metastatic biliary tract carcinoma. The schedule of chemotherapy included O
100
mg/m2 on day 1 and G 1000 mg/m2 on days 1 and 8, every 21 days. Inclusion
Criteria were: histological diagnosis of biliary tract carcinoma, age <75,
Performance Status (PS)<=2, normal kidney and liver function, absence of
brain
symptomatic metastases, informed consent.Median patient age was 68 years
(range
59 -73). At present 24 pts ,15 males and 9 females, have been enrolled. Nine
pts
had carcinoma of the gallbladder, 7 cholangiocarcinoma and 8 extrahepatic
biliary system disease. Locally advanced 14 pts, metastatic 10 pts. Thirteen
pts
had a PS =0, 7 pts had a PS=1, 4 pts had a PS=2. Results: All the 24 pts
were
evaluable for response and toxicity. According RECIST criteria we observed 1
CR
and 11 PR for an overall response rate of 50 %. Five SD and 7 PD also
occurred.
The responders (PR+CR) demonstrated a TTP of 10 months (range 6-24) and an
overall survival of 14 months (range 6 - 2Cool, while the overall survival for
all
the pts on study was 10 months (range 2-2Cool. According WHO criteria, 6 pts
(25%)
suffered grade 2-3 neutropenia, and 3 pts (12.5%) grade 2 thrombocytopenia.
One
third of pts developed grade 1-2- peripheral neuropathy, only 2 pts (8%)
suffered grade 3 neuropathy . Nausea & vomiting G1-2 was present in 6 pts
(25%).Conclusions: From these preliminary data O and G combination seems to
be
effective with a favorable safety profile in first line chemotherapy of
advanced
biliary tract cancers.
Back to top
Steph
medicine forum Guru


Joined: 03 May 2005
Posts: 504

PostPosted: Wed Jun 01, 2005 11:41 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:Ifone.503$Wk4.11300@news.uswest.net...
Quote:
Can anyone provide references or data that could help persuade an
insurance
company to pay for oxaliplatin to treat cholangiocarcinoma? Insurance
claims have been denied, apparently on grounds that this is not a standard
treatment. Thanks.

- Bob



What do you expect oxaliplatin to achieve?
Back to top
alex
medicine forum beginner


Joined: 25 May 2005
Posts: 2

PostPosted: Wed Jun 01, 2005 8:21 pm    Post subject: Re: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

Call customer service on the back of your insurance card. Ask for your
explanation of benefits which will detail your plan. Also ask what your
appeal rights are and what is the process.

Depending on the language in your benefits write a letter asking them to
appeal their decision. For example, if the benefit states that experimental
treatment isn't covered. Have your oncologist write this isn't
experimental.

Alex

--

"farrell77" <farrell77@spamfree.yahoo.com> wrote in message
news:Ifone.503$Wk4.11300@news.uswest.net...
Quote:
Can anyone provide references or data that could help persuade an
insurance
company to pay for oxaliplatin to treat cholangiocarcinoma? Insurance
claims have been denied, apparently on grounds that this is not a standard
treatment. Thanks.

- Bob

Back to top
farrell77
medicine forum beginner


Joined: 01 Jun 2005
Posts: 47

PostPosted: Wed Jun 01, 2005 5:45 pm    Post subject: Use of Oxaliplatin for Cholangiocarcinoma? Reply with quote

Can anyone provide references or data that could help persuade an insurance
company to pay for oxaliplatin to treat cholangiocarcinoma? Insurance
claims have been denied, apparently on grounds that this is not a standard
treatment. Thanks.

- Bob
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